Provider Demographics
NPI:1275850539
Name:MYERS, KATIE J (MED)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:MYERS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4148 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1731
Mailing Address - Country:US
Mailing Address - Phone:918-779-6899
Mailing Address - Fax:
Practice Address - Street 1:4148 E 36TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1731
Practice Address - Country:US
Practice Address - Phone:918-779-6899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool